Pursuing the Promise of Smart Joint Implants

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Joint arthroplasty is a highly successful procedure – yet patients sometimes require revision surgery due to implant failure or infection. To combat those problems, research performed by Valentin Antoci, MD, PhD, an orthopedic surgeon, focuses on tissue engineering, smart joint implant design, and cellular-molecular interactions at the implant interface. The objective of his work is the development of novel techniques and material modifications that directly change the surface interactions between bone cells and the metal to prevent implant loosening, biofilms and infection, and ultimately prevent failure. His previous research produced titanium alloy surfaces that were able to fight and prevent infection, as well as promote bone ongrowth through the attachment of osteoconductive peptides.

Current data show that over 60 percent of implant failure are caused by loosening of the implant, with as many as 10 to 20 percent of revision cases related to infection. Dr. Antoci, in collaboration with Dr. Shukla of the School of Engineering at Brown University, as well as other institutions across the country, are exploring various techniques and materials for use in surgery, including the engineering of “smart” surfaces that react to their immediate environment, bone cements and hydrogels for targeted delivery of antibiotics, as well as enzymatic and chemical processes for eradication of local infection.

Dr. Antoci is working on improving the clinical surgery of early irrigation and debridement by defining specific chemical and molecular signals that may fight and eradicate deep biofilms. Ultimately, the division, especially Dr. Born and Dr. Garcia, is looking at both treatment but also early diagnosis, with new rapid diagnostic tests able to literally see and identify the microbe causing an infection on an implant in as little as 30 minutes. Combined, Dr. Antoci and his collaborators have the unique clinical and basic science expertise to address orthopedic infections, from early diagnosis, simple treatments, as well as complex reconstructions and revision surgeries.